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Safety and Effectiveness of High-Intensity Statins Versus Low/Moderate-Intensity Statins Plus Ezetimibe in Patients With Atherosclerotic Cardiovascular Disease for Reaching LDL-C Goals: A Systematic Review and Meta-Analysis.
- Source :
-
Clinical cardiology [Clin Cardiol] 2024 Aug; Vol. 47 (8), pp. e24334. - Publication Year :
- 2024
-
Abstract
- Background: It remains controversial whether adding ezetimibe to low/moderate-intensity statins has a more beneficial impact on the treatment efficacy and safety of patients with existing atherosclerotic cardiovascular disease (ASCVD) compared to high-intensity statin regimens.<br />Hypothesis: A combination of low/moderate-intensity statins plus ezetimibe might be more effective and safer than high-intensity statin monotherapy.<br />Methods: We searched databases for randomized controlled trials comparing lipid profile alterations, drug-related adverse events, and MACE components between high-intensity statin monotherapy and low/moderate-intensity statin plus ezetimibe combination therapy. Pooled risk ratios (RR), mean differences (MD), and 95% confidence intervals (95% CI) were estimated using a random-effects model.<br />Results: Our comprehensive search resulted in 32 studies comprising 6162 patients treated with monotherapy against 5880 patients on combination therapy. Combination therapy was more effective in reducing low-density lipoprotein cholesterol (LDL-C) levels compared to monotherapy (MD = -6.6, 95% CI: -10.6 to -2.5); however, no significant differences were observed in other lipid parameters. Furthermore, the combination therapy group experienced a lower risk of myalgia (RR = 0.27, 95% CI: 0.13-0.57) and discontinuation due to adverse events (RR = 0.61, 95% CI: 0.51-0.74). The occurrence of MACE was similar between the two treatment groups.<br />Conclusions: Adding ezetimibe to low/moderate-intensity statins resulted in a greater reduction in LDL-C levels, a lower rate of myalgia, and less drug discontinuation compared to high-intensity statin monotherapy in patients with existing cardiovascular disease. However, according to our meta-analysis, the observed reduction in LDL-C levels in the combination group did not correlate with a reduction in MACE compared to the high-intensity statin group.<br /> (© 2024 The Author(s). Clinical Cardiology published by Wiley Periodicals, LLC.)
- Subjects :
- Humans
Treatment Outcome
Atherosclerosis drug therapy
Atherosclerosis blood
Biomarkers blood
Ezetimibe therapeutic use
Ezetimibe administration & dosage
Ezetimibe adverse effects
Hydroxymethylglutaryl-CoA Reductase Inhibitors therapeutic use
Hydroxymethylglutaryl-CoA Reductase Inhibitors administration & dosage
Hydroxymethylglutaryl-CoA Reductase Inhibitors adverse effects
Cholesterol, LDL blood
Drug Therapy, Combination
Anticholesteremic Agents therapeutic use
Anticholesteremic Agents administration & dosage
Anticholesteremic Agents adverse effects
Subjects
Details
- Language :
- English
- ISSN :
- 1932-8737
- Volume :
- 47
- Issue :
- 8
- Database :
- MEDLINE
- Journal :
- Clinical cardiology
- Publication Type :
- Academic Journal
- Accession number :
- 39135464
- Full Text :
- https://doi.org/10.1002/clc.24334